Friend in hospital

[Dogzndiamonds]

Wondering if anyone can relate to this & offer any advice/support. My friend was admitted to hospital just over two weeks ago with off the scale billirubin levels. She was canary yellow. She has very swollen legs, bad ascites (she looks 9 months pregnant), varices on her chest & is in a lot of pain.

I have always been worried about her levels of drinking but she assures me that she "used to drink too much but now only drinks moderately".

She has told me that part of her liver is scarred due to past drinking but that another part of her liver isn't working properly due to an infection. I am not sure what sort of infection would cause symptoms identical to liver disease.

Will the hospital staff realise that she is clearly an alcoholic and have been giving her detox medication, even if she is unaware of this? Or will they take her at face value when she says that she doesn't drink too much?

Also, is it likely that she can recover from this? She isn't even 40 yet :(

[Jackydaytona]

I'm sorry

She sounds end stage liver failure

[Duolily]

im so sorry. Yes I’m sure they will work out what’s going on, alcoholics are very often in denial about their condition and how much they drink, they’ll have seen it before

[Summer2424]

Hi @Dogzndiamonds
I'm sorry about your friend being in hospital xx
My Dad died of Alcoholism, his go to drink was vodka straight from the bottle. He had no problems with his liver but his intestines had basically died.
I'm hoping that your friends liver is just an infection and will get better. The doctors i hope will advise her about alcohol and this will hopefully change her ways. Hope your friend makes a full recovery xx

[2023forme]

@Dogzndiamonds I’m sorry to hear about your friend.

It sounds like she has liver failure, the main cause of high bilirubin - gallbladder cancer, pancreatitis, obstruction of bile duct can also cause high bilirubin/jaundice but it is more likely to be a liver problem especially with the ascites and her alcohol history.

She cannot be given medication without her consent unless she is mentally/physically unable to consent or has a covert medication order signed off by a psychiatrist (unlikely).

Medics will need to rule out other problems (such as gallbladder cancer) but they will likely know this is sadly end stage alcoholic liver disease. I’m sorry to say this is unlikely to be reversible but sometimes the separate problems can be treated eg draining the ascities, beta blockers/ligation of varicies, antibiotics for infection. If it is end stage liver disease, the only real treatment would be liver transplantation if she was a candidate.

I’m so sorry for your friend too - I am a problem drinker so no judgement as I know how hard the struggle is. It must be awful for you, trying to deal with this and I hope you are getting support too. 💐

[mindutopia]

I'm really sorry that your friend is going through this and how lovely of you to be supporting her.

Yes, they will absolutely be aware that her drinking is an issue, even if she hasn't told them this. It won't be their first rodeo. They'll have seen this a million times before and there are blood tests that can be done (which she most certainly will have had done) that indicate if liver damage is related to alcohol. Those will be high, so given her age, it will be the working assumption.

Someone with any degree of liver damage should be no longer drinking. The fact she has chosen to drink at all - even if she claims it's less - will be a massive red flag to HCPs. So they will know.

The bigger question is, will she accept it herself? And will she be willing to take help?

[Dogzndiamonds]

Thanks all for taking the time to reply and for your really kind words.

I guess I was worried that the medical staff would be as gaslit as we all have been by her. It's so desperately sad that, even lying in a hospital bed, she cannot admit that she is killing herself with alcohol. Her downplaying and denial is something I can't quite get my head round.

If she does come out of hospital, I have discussed with a mutual friend that we aren't going to enable her drinking ever again. No pub trips, no boozy nights, no drinking around her. I keep thinking forwards to her funeral... I want to feel at peace that I did everything I could to try to help her turn her life around. It's just so shit :(

[Fudgeandcaramel]

Doctors will take into account all aspects of the presentation to make a call about prescribing a detox - it isn’t uncommon for people to be embarrassed about their alcohol intake and so perhaps under report. That having been said, if your friend has significant liver scarring even a lower risk drinking pattern can precipitate what you describe - decompensation - and an infection can too - basically your liver becomes less resilient and things which wouldn’t usually affect it can stop it processing things (like bilirubin). Although it sounds like she is seriously ill, people can sometimes come through this and recompensate - especially if they stop drinking completely - fingers crossed she will. It sounds like you are a lovely supportive friend. Letting her know that you are more than happy to do things with her which don’t involve alcohol may be a good idea - people often worry about what their friends will think about their quitting it especially if you’ve previously drunk together. Thoughts with you both.

[Silverdogblue]

My mother had precisely these symptoms, didn’t abstain and lived another 20 years. So whilst you should prepare for the worst, it may not happen.

These are barn door symptoms of chronic alcoholism though so the medics will know.

[Dogzndiamonds]

My friend has been discharged from hospital so is now back in her own home where she lives on her own.

She refused to let her Dad or anyone else be there for her outpatients planning appointment where I presume they will have told her, along with many other things, that she cannot touch another drop of alcohol.

She still is jaundiced & has ascites but they have been weighing her every day to monitor the fluid I guess & are happy that it is no longer getting worse.

So this is it isn't it? Crunch time. Can she/will she completely change her lifestyle in order to live, or will she immediately open a bottle of wine & tell us all that it's fine & the doctors just told her that she needed to reduce her alcohol consumption? Or will she hide gin in her water bottle to hide her secret again, which is what she was doing before her admission.

I will go & see her at hers this week. I really hope she can give it up but is that even possible without any support/admission that you have a problem??

[NCgoingdry]

It sounds as though, as she's so unwilling to let anyone else be involved - she's not taking the support plans or suggestions being put in place by the medical professionals.

[mindutopia]

She will need to admit she has a problem and she will need support. There's a couple things I'd suggest - things that helped me or might have helped me, if someone suggested it.

Have you told her you are worried about her drinking? I mean, really sat her down and talked to her about how you are worried about her, how you thought you were going to lose her, how you think she will die if she doesn't get help. When dh did this with me, it didn't mean I stopped drinking the next day. Actually, I drank for another 6 months before I finally quit. But it planted the seed. It wasn't the only seed. A few others were planted.

Secondly, would you offer to go to a meeting with her? You'll need to be careful you find an open meeting (not all AA meetings are open to everyone, I assume you just look at the schedule to figure out, closed meetings are only for alcoholics, not friends/family). Or could you offer to drive her to a meeting and then plan to go out for coffee or cake after just so she can talk if she wants to?

[lizkt]

I was wondering how you're getting on OP. I am in a similar situation with my friend who was diagnosed with ascites. All the indications are that he is not going to stay away from alcohol which seems astonishing. But then again, from my experiences in Al anon, it's not that unusual for them to relapse.

[Dogzndiamonds]

Thanks for asking. She is out of hospital & busy putting good habits into practice. She is 100% focussing on food, exercise and stopping smoking, avoiding any conversation around alcohol other than to say that she is not drinking 'for a while'. She still has not admitted to alcohol being the cause of her recent hospital stay. Her birthday is coming up & she has said that she is going to ask her Consultant whether she can have 'a glass of something' to celebrate her birthday. Now, we all know the answer will be a resounding 'no' from any medical professional but I am sure she will use it as the excuse to allow alcohol to creep back into her life. I am in this off limbo with it all, the intensity of a hospital stay has worn off & she is just back to living what all of us around her can see as this big fat denial/lie. It frustrates me & makes me super sad in equal measure. But onwards we go...She is obviously making big steps to improve as her ascites and jaundice have decreased considerably, but I remain unfortunately pessimistic that this is all just a pause in an unwavering spiral of alcoholism. Sorry, that's not very upbeat is it. Maybe I should be more hopeful but I don't think I am. It's frankly exhausting & my deepest sympathy is with anyone who has a friend/loved one/family member who is affected by alcohol. It is one massive headf*ck.

[Brocollimatilda]

I’m sorry OP. That must feel like watching a car crash in slow motion. It’s so terribly, terribly sad. Maybe that moment of realisation will come.

I identify with a lot of what you say. I have struggled with knowing the difference between support and enabling (think I have worked out that line in my head now). Have also had to practise detaching. That is probably the most helpful thing I have done for my friend and most sanity saving thing I have done for me. There’s something about being as neutral as possible around someone’s drinking (holding both pessimism and optimism at bay) that means you can be there if needed/wanted without exerting pressure on the person but can also protect yourself.

[lizkt]

@Dogzndiamonds Thanks for the update, it sounds so similar to my friend in that they haven't acknowledged its alcohol that led to this. So how do you even broach the subject anyway? Not that it would change anything, tbh. These things are so rooted. You can see them justifying why another drink would be great.

@Brocollimatilda I find it eternally difficult, finding the right line to walk. On the one hand feel so mad and want to distance myself forever. Then I feel pity and sadness and guilt.

[Sillymummies123]

Will they find out? Put it this way - I'm only halfway through a medical degree and if I saw just half the signs you describe my alcohol alarm bells would be ringing on overdrive. So yes - unless they're neglectful, they'll know. The bigger worry is - will they be too jaded and accustomed to it (especially if she's on a hepatobiliary ward) to challenge her too hard!

Best wishes- if she's at external varices stage, prognosis isn't great I'm afraid.

[Brocollimatilda]

@lizkt it is hard. When my friend is drinking I am now the person who supports them - both physically (they need a lot of care when drinking) & mentally/emotionally (as much I can). I also deal with the hospital visits, and trying to get appropriate support. So I just had to find a way to detach & not think about it or I wouldn’t be able to cope with the anxiety of when it might happen again - and I don’t think that would be helpful as it would make me questioning and suspicious. I also read widely to better understand my friend’s drinking and how friends can best support - what’s helpful and what isn’t. And they have spoken a lot to me about it.

It saved me really knowing that there is nothing I can do or say to stop my friend drinking. They are the only person who can make that decision. It took me time to get my head around that. Alcohol services are all very clear about that. I got there. It meant I could let go and importantly step back. I don’t feel guilty as I can see it means I can be there when needed and I can be there for the long haul even if it keeps happening. We can still talk about drinking etc and I can still challenge some of the stuff that gets said - but by parking my concerns it means I am not trying to prove anything or argue anything and there’s no pressure to make any changes for me. I try to be a sort of calming influence/support. Unshockable and reliable but not invested personally in whether they drink or not. My concern is around the damage they do to themselves and their life when they do.

There has been a significant sober period at the moment but I am still practising being neither optimistic or pessimistic - whilst being very vocal & positive about the changes they have made (because they are great, they really are).

I haven’t been to Al-anon but I think they talk an about some if this.

[tribpot]

I'm glad you're being realistic about the improvements made so far, @Dogzndiamonds . I think it's the only way to protect yourself for what seems very likely to follow. Who knows what the consultant will say to her - he/she may feel it's better for the patient to trust in them and willing to stay mainly compliant with treatment, rather than issue a blanket 'no' and risk never seeing the patient again.

I assume there is no chance she is engaging with addiction services, since she's in complete denial. At some point, and in the spirit of knowing you did everything you could, I think I would have a very frank conversation with her. At the moment she may believe everyone has bought into the cover-up job she's been doing.

Have you and your other friend put into place the plan you had when she was in hospital, i.e. no boozy lunches, no pub trips?

[Brocollimatilda]

I think the other thing - after a quick reflection - is to be careful your friendship doesn’t become all about drinking. When you realise the extent of a problem a friend has for a while that’s all you can think about. I prefer talking about other stuff tbh!

And yes did you drop the boozy lunches etc? Have you found an alternative that works for your friendship group?

[Dogzndiamonds]

Thanks all, some really helpful suggestions & opinions that I've read through.

Yes, the boozy lunches & nights have stopped. I made a commitment to myself that I didn't want to enable her drinking by drinking with her anymore. I can't control what she does but I can control what I do - that makes me feel like I have a tiny bit of control over something in this situation. The trouble is that it makes me feel a bit apprehensive when we make a plan to see each other as it always involved a pub or her coming to socialise/drink at mine so I must admit I am sometimes at a loss of what to suggest without it feeling forced. She has bailed on me the past couple of times we have made plans...I have been relieved I think. But also feel guilty for not wanting to be there for her more.

[Usou]

Some alcoholic's denial is so strong they are beyond help. There is a very definite limit to what you can do.

Your friend is very lucky to still have people looking out for her. These usually fade away as the situation gets more painful.

You could tell her that you'll always be there for her, but that you are stepping away as it's too hard to watch her drink herself to death. This may initially feed her alcoholic' self-pity, and she may also feel relief that she can drink without restrictions. But it may also bring the cold light of reality flooding in and make her seek help.

It's a tough one - some seem programmed to die, but there are also miraculous recoveries.

How's your own drinking? You sound like you can put them away.

A sober alcoholic.